Breakout L – May 17, 3013
1. Scaling Up & Sustaining Alcohol & PTSD Screening & Intervention in US Trauma Care Systems
Presenter: Douglas Zatzick, MD
Authors: Douglas Zatzick, MD,1,2 Dennis Donovan, PhD,1,3 Chris Dunn, PhD,1,2 Frederick Rivara, MD, MPH,1,2 Larry Gentilello, MD,1,2 Joan Russo, PhD,1 Jin Wang, PhD,2 Jeff Love,BA,1 Collin McFadden, BA,1 & Gregory Jurkovich, MD4
1University of Washington School of Medicine; 2Harborview Injury Prevention & Research Center; 3Alcohol & Drug Abuse Institute; 4Denver Health Care System, Denver, CO
Abstract: The American College of Surgeons Committee on Trauma tightly regulates United States (US) trauma center care through policy mandates and clinical guideline best practice recommendations. College mandates are reinforced through verification site visit implementation criteria. The American College of Surgeons has successfully linked trauma center funding to verification site visits and other quality indicators. This presentation will describe a unique investigative-policy collaboration whereby federally funded empiric research on posttraumatic stress disorder (PTSD), and alcohol/drug screening and intervention has been directly translated to policy mandates and clinical guidelines for acute care medical trauma centers nationwide. The presentation will first describe the randomized clinical trial evidence base supporting alcohol and PTSD screening and intervention in acute care medical settings. Next, the presentation will focus on recent policy summits with the American College of Surgeons that have allowed for the scaling up of results of single site randomized clinical trials across trauma care systems nationwide. Findings suggest that regulatory requirements developed in concert with multidisciplinary implementation team oversight may optimally enhance the scaling up and sustainability of behavioral health treatment integration in acute care trauma center medical settings.
2. Lessons Learned from Implementing a Web-Based Tool for Brief Alcohol Interventions in a Large Integrated Health Care System
Presenter: Kenneth R. Weingardt, PhD
Kenneth R. Weingardt, PhD,1,2 Michael A. Cucciare, PhD,2,3 Paula L. Wilbourne, PhD,1 & John S. Baer, PhD4
1Veterans Health Administration; 2Stanford University; 3Center for Health Care Evaluation, VA Palo Alto; 4University of Washington & VA Puget Sound Health Care System
Abstract: Research has demonstrated that computer-based brief motivational interventions can be an efficacious means of reducing alcohol use and alcohol-related problems. The authors designed and built a web-based brief alcohol intervention for use in the Department of Veterans Affairs (VA) in 2005. This presentation summarizes the projects and initiatives that have been undertaken in the ensuing years to support the implementation of this tool into clinical practice. Projects have focused on a variety of clinical settings, including outpatient Readjustment Counseling (Vet Centers), specialty care for PTSD and Substance Use Disorders, and Integrated Primary Care. The authors will provide a narrative description of each initiative, and use the Consolidated Framework for Implementation Research (CFIR) to communicate how various contextual factors acted as barriers and facilitators within each setting. The presentation concludes with a summary of lessons learned, and a description of how these lessons are informing current efforts to implement the web-based brief alcohol interventions in HCV clinics, and as part of a national initiative to roll out Motivational Enhancement Therapy (MET).
3. Disseminating Contingency Management: A Training & Implementation Trial
Presenter: Bryan Hartzler, PhD
Author: Bryan Hartzler, PhD, Alcohol & Drug Abuse Institute, University of Washington
Abstract: Contingency Management (CM) is an empirically-validated behavioral treatment, for which community dissemination has been surprisingly slow. Given the considerable evidence accumulated for its efficacy, examination of implementation outcomes is paramount. A recent study involved the collaborative design of a CM intervention by a university investigator and partnering community addiction treatment clinic. The study then formally evaluated immediate impacts of a 16-hour training workshop with clinic personnel, as well as well as eventual impacts following a 90-day trial implementation period. A mixed method design allowed repeated measurement of clinician-focused implementation (acceptability, appropriateness, adoption, fidelity) among 17 staff clinicians and qualitative retrospective measurement of management-focused implementation outcomes (cost, feasibility, penetration, sustainability) among 5 executive staff. Broad clinical outcomes of the intervention were also examined via review of patient medical records, and compared to a historical control. The presentation will outline: 1) the processes of intervention design and staff training, 2) immediate and eventual impacts of training on clinician-focused implementation domains, 3) qualitative report of clinic executives concerning management-focused implementation domains following the trial implementation period, and 4) patient-based intervention outcomes. The study offers a formal, comprehensive evaluation of staff training and implementation of CM at a community addiction treatment clinic, and collective results may provide useful insights for those working in or collaborating with community treatment programs.